References
Contraception consultation and assessment for women over 40
Abstract
Access to contraception is a basic human right, and one that empowers women to support pregnancy planning. When assessing a woman over the age of 40 for contraception, concerns such as comorbidity, changes to menstrual pattern, irregular bleeding and the management of additional perimenopausal and menopausal symptoms are essential considerations. While many methods of contraception can be used in menopause, some may need to be changed to safer, alternative methods. Most women will require some form of contraception (often taken alongside hormone replacement therapy) until the age of 55 years. This article will focus on contraception consultation and assessment, prescribing considerations in relation to age and menopause, contraceptive formulations (hormonal methods and the copper IUD) and the potential health implications of using specific forms of contraception.
A woman's reproductive age is defined as being between 15 and 49 years of age and in 2017, there were 1.9 billion women of reproductive age in the world (World Health Organization (WHO), 2020).
Conception is defined as the successful fertilisation of ova by spermatozoa. According to the WHO, successful use of contraception enables women to determine how and when they want to have children. In healthcare practice this is usually referred to as ‘family planning’. Worldwide, the number of women using modern contraception has increased, rising from 73.6% in 2000 to 76.8 % in 2020, equating to over 842 million women (WHO, 2020).
Contraception works in the following variety of ways (NHS Inform, 2022):
There are multiple forms of contraception available in the UK; however, the only one that can prevent both pregnancy and the transmission of sexually transmitted infections is the condom (WHO, 2020; NHS Inform, 2022). The most popular form of contraception in the UK overall continues to be the oral contraceptive pill. However, there has been an increase in the use of long-acting reversible contraceptives (LARCs), with intrauterine devices becoming more popular in women over the age of 35 years (NHS Digital, 2022).
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